Alexander S Guareschi, Caroline P Hoch, James M Deacon, Josef K Eichinger, Richard J Friedman, Christopher E Gross, Daniel J Scott
{"title":"Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital.","authors":"Alexander S Guareschi, Caroline P Hoch, James M Deacon, Josef K Eichinger, Richard J Friedman, Christopher E Gross, Daniel J Scott","doi":"10.5435/JAAOS-D-23-00901","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.</p><p><strong>Methods: </strong>Retrospective cost and time data were obtained from 175 surgeries performed from 2019 to 2020 using a single institution's existing cost accounting system (hospital = 97, ASC = 78). In addition, 34 patients were prospectively enrolled undergoing primary anatomic (n = 10) or reverse (n = 24) TSA. Hand-timed data were collected at each location (ASC = 23, hospital = 11) throughout the entire episode of perioperative care. Data were analyzed to investigate the effects of surgery location on labor cost, efficiency, and provider time.</p><p><strong>Results: </strong>The cost per TSA in the ASC was markedly lower than that in the hospital (ASC = $27,250.59, hospital = $30,266.80; P < 0.001). Examining individual discrete activities, TSA performed at the ASC was markedly longer in multiple preoperative, intraoperative, and postanesthesia care unit categories, with the greatest difference being case duration (ASC = 2.2 hours, hospital = 1.7 hours; P = 0.002). The decreased cost in the ASC, despite longer case duration, can be explained by differences in cost margins between locations with ASC cases having markedly lower costs for almost all categories.</p><p><strong>Conclusion: </strong>It is markedly more expensive for patients to undergo TSA in a hospital setting than in an ASC. Furthermore, preoperative and postanesthesia care unit times markedly contribute to differences in efficiency associated with different surgical platforms, representing target areas to focus on improving efficiency of care delivery. These findings should be considered by orthopaedic surgeons when considering TSA in patients who are suitable to undergo TSA at an outpatient ASC.</p><p><strong>Level of evidence: </strong>Level II, Prospective cohort study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-23-00901","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.
Methods: Retrospective cost and time data were obtained from 175 surgeries performed from 2019 to 2020 using a single institution's existing cost accounting system (hospital = 97, ASC = 78). In addition, 34 patients were prospectively enrolled undergoing primary anatomic (n = 10) or reverse (n = 24) TSA. Hand-timed data were collected at each location (ASC = 23, hospital = 11) throughout the entire episode of perioperative care. Data were analyzed to investigate the effects of surgery location on labor cost, efficiency, and provider time.
Results: The cost per TSA in the ASC was markedly lower than that in the hospital (ASC = $27,250.59, hospital = $30,266.80; P < 0.001). Examining individual discrete activities, TSA performed at the ASC was markedly longer in multiple preoperative, intraoperative, and postanesthesia care unit categories, with the greatest difference being case duration (ASC = 2.2 hours, hospital = 1.7 hours; P = 0.002). The decreased cost in the ASC, despite longer case duration, can be explained by differences in cost margins between locations with ASC cases having markedly lower costs for almost all categories.
Conclusion: It is markedly more expensive for patients to undergo TSA in a hospital setting than in an ASC. Furthermore, preoperative and postanesthesia care unit times markedly contribute to differences in efficiency associated with different surgical platforms, representing target areas to focus on improving efficiency of care delivery. These findings should be considered by orthopaedic surgeons when considering TSA in patients who are suitable to undergo TSA at an outpatient ASC.
Level of evidence: Level II, Prospective cohort study.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
